LARYNGOPHARYNGEAL

REFLUX (LPR)

FUAD FAUZI
 mengalirnya kembali isi gaster melalui esofagus
ke laring dan hipofaring

 manifestasi ekstraesofageal dari

gastroesophageal reflux disease (GERD) yang
tersering

 kejadian reflux pada individu :

50 X GER / day  normal
1 X LPR / day  disease
 laring tidak mempunyai proteksi:
bikarbonat saliva
endogenous tissue buffering 2
gerakan peristaltik
 LPR vs GERD
LPR
 Berdehem (93%)
 Heartburn (20%)
 Suara parau
 Inflamasi laring
 pH faring abnormal
 Upright-Day time refluxers
 PPI 2 x sehari
GERD
 Berdehem(3%)
 Heartburn (83%)
 Parau <<<
 Esophagitis
 pH esofagus abnormal
 Dismotilitas esofagus
 Abnormal esophageal
clearance
 Supine-Nocturnal refluxers
 PPI 1 x sehari
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4
 Barrier fail :
refluxate
Altered of ciliated respiratory
Of the posterior larynx direct refluxate

Mucus stasis result in: irritation, vagal

Post nasal drip sensation

coughing
Vocal cord edema choking
Contact ulcers (laryngospasm)
Granulomas
Hoarseness
Globus pharyngeus
Sore throat
Ford CN. JAMA,2 005;294;1534-9
ETIOLOGI
Physical Lifestyle

 Improper functioning of  Diet :

UES & LES  Tomato, citrus
 Chocolate, coffee, fatty
 Hiatal Hernia foods,spices
 Abnormal esophageal  Medicine :
contractions  NSAID
 Slow emptying of the  Aspirin
stomach  Unhealthy habits :
 Over-eating,
 smoking,
 alcohol
DIAGNOSIS
 Gejala– RSI (>13)
 Pemeriksaan laring– RFS (>7)
 Tes diagnosisi khusus:
 - Barium esophagography
 - Esophageal/Pharyngeal manometry
 - Double-probe pH monitoring
 - Pepsin immunoassay
 - Empiric antireflux treatment

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 REFLUX SYMPTOM INDEX (RSI)
Within the last month, how did the following 0 = No Problem
problems affect you? 5 = Severe Problem
Circle the appropriate response
1. Hoarseness or a problem with your voice 0 1 2 3 4 5
2. Clearing your throat 0 1 2 3 4 5
3. Excess throat mucus or postnasal drip 0 1 2 3 4 5
4. Difficulty swallowing food, liquids, or pills 0 1 2 3 4 5
5. Coughing after you ate or after lying down 0 1 2 3 4 5
6. Breathing difficulties or choking episodes 0 1 2 3 4 5
7. Troublesome or annoying cough 0 1 2 3 4 5
8. Sensations of something sticking in your 0 1 2 3 4 5
throat or a lump in your throat
9. Heartburn, chest pain, indigestion, or 0 1 2 3 4 5
stomach acid coming up
TOTAL

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 Reflux Finding Score (RFS)
Subglottic edema 0 = absent
2 = present
Ventricular obliteration 2 = partial
4 = complete
Erythema/hyperemia 2 = arytenoids only
4 = diffuse
Vocal fold edema 1 = mild
2 = moderate
3 = severe
4 = polypoid
Diffuse laryngeal edema 1 = mild
2 = moderate
3 = severe
4 = obstructing
Posterior commissure 1 = mild
hypertrophy 2 = moderate
3 = severe
4 = obstructing
Granuloma/granulation tissue 0 = absent
2 = present 9
Thick endolaryngeal mucus 0 = absent
2 = present
Typical Appearance of LPR :
- pseudosulcus vocalis
- ventricular obliteration
- posterior commisure hypertrophy
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- diffuse laryngeal edema
▪ Pseudosulcus vocalis
- edema extends past the vocal process to
posterior larynx
▪ Posterior commisure hypertrophy 11
 Ventricular obliteration
a. Open laryngeal ventricles b. Ventricular obliteration
- sharp ventricular band - true & false vocal folds are
- open space between true swollen
& false vocal folds - mild posterior commisure
hypertrophy
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 Vocal fold edema
a. Mild vocal fold edema b. Moderate vocal fold edema
- pseudosulcus vocalis
- post commis hypertrophy
- partial vent obliteration
c. Severe vocal fold edema d. Polypoid degeneration 13
- sessile changes - severe post commis hypertrophy
- pseudosulcus vocalis
 Posterior commissure hypertrophy
a. Normal posterior commis b. Mild post comm hypertrophy
- slight mustache-like configuration
- pseudosulcus vocalis

c. Moderate post comm hypertr d. Severe post comm hypertrophy 14

- straight line across the post - total ventric obliteration
- pseudosulcus vocalis - diffuse laryngeal edema
LPR with polypoid degeneration :
- pseudosulcus vocalis
- complete ventricular obliteration
- fusiform swelling of both cords 15
- posterior laryngeal erythema and edema
Laryngeal granulomas in a patient with numerous episodes
of pharyngeal acid exposure and no history of intubation16
TERAPI
 modifikasi gaya hidup

 modifikasi diet

 obat-obatan Antasida, PPI, antagonis H2 reseptor

 pembedahan anti-refluks

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MODIFIKASI GAYA HIDUP
 tidur dengan kepala ditinggikan
 menghindari makan yang berlebihan
 tidak makan-minum 3 jam sebelum tidur
 menghindari peningkatan tekanan intra-abdominal
(memakai ikat pinggang ketat, memakai korset ketat)
 berhenti merokok
 menurunkan berat badan.

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MODIFIKASI DIET
 mengurangi atau mennghindari :
makanan berlemak, pedas atau digoreng, makan
coklat
minum minuman bersoda
minum alkohol, jus tomat atau jus jeruk.

 Dianjurkan sering mengulum permen karet

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 OPERASI

 kegagalan terapi obat-obatan

 komplikasi RLF dan penderita yang sulit untuk pemberian
obat-obatan jangka panjang misalnya pasien muda / kecil
 pengguna suara yang profesional seperti penyanyi atau
presenter.

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